Maine advocates are working to improve vaccination rates

New whooping cough infections in October in Maine, jumped to highest monthly total in 2018

Advocates think bill to end most exemptions from childhood vaccinations has a shot

Maine has the nation's 7th-highest rate of non-medical opt-outs and high rates of infectious diseases like whooping cough.

by Joe Lawlor

A bill that would end non-medical exemptions from childhood vaccinations will go before the Legislature this year, and public health advocates are optimistic about the measure’s prospects.

Maine has one of the worst vaccination rates for children entering kindergarten in the nation, and the country’s highest rate of pertussis, a vaccine-preventable disease also known as whooping cough.

If approved, Maine would be the fourth state – following California, Mississippi and West Virginia – to ban all non-medical exemptions that allow parents to forgo school-required vaccines for their children.

In Maine, current state law permits parents to skip vaccines for their children by signing a form opting out on philosophic and religious grounds. In the 2017-18 school year, 5 percent of Maine children entering kindergarten – about 600 children statewide – had non-medical exemptions for immunizations, state statistics show.

Thirty-one public elementary schools were reporting 15 percent or higher rates of unvaccinated kindergarten students, putting those schools and the surrounding community at greater risk for the return of preventable diseases such as measles, chickenpox and pertussis.

Dr. Linda Sanborn, a family physician and a Democratic state senator from Gorham, said advocates are focused on protecting children from infectious diseases such as measles. 

New York City is now experiencing a measles outbreak that started among unvaccinated children, with more than 180 cases in an Orthodox Jewish community, according to news reports. 

In 2014-15, a measles outbreak in California that started at Disneyland sickened hundreds.

The World Health Organization (WHO) issued a report Thursday that said “vaccine hesitancy” has become a global health threat.

“We should be doing all we can for these children. Their safety is so important,” said Sanborn, a co-sponsor of a bill with Rep. Ryan Tipping, D-Orono.

Tipping said the birth of his daughter a year ago spurred him to think about public policy in different ways.

“When you have a child, it opens your eyes to a lot of issues that should be changed in this world to make it a better place for your kid and all children,” Tipping said. “Schools and day cares should be a safe place for children to attend.”

A bill to make it more difficult to opt out of vaccines – by requiring a medical professional to consult with parents and sign off on the exemption – died in the Legislature in 2015, after lawmakers upheld a veto by then-Gov. Paul LePage.

Gov. Janet Mills, the newly elected Maine governor, has not stated a position on the bill, but pro-vaccine advocates are confident and made the measure more strict by eliminating all non-medical exemptions rather than requiring another step to opt out, as the 2015 bill would have done.

Mills spokesman Scott Ogden said the governor will examine the merits of the bill.

“Governor Mills will carefully review any legislation to modify current state vaccination policy, and she encourages all parents to have their children vaccinated,” Ogden said in a statement. “As a general matter, she believes that vaccinations are critical to protecting the health and welfare of Maine people.”

Maine's opt-out rate is among the highest


Medical opt-outs in Maine are extremely rare – only 0.3 percent of all vaccine opt-outs were for medical reasons, such as a child with leukemia, according to state statistics.

Maine experienced an increase in pertussis cases in 2018, from 410 in 2017 to 446, according to the Maine Center for Disease Control and Prevention. Several schools reported outbreaks this fall, including in Scarborough, Biddeford and Kennebunk, and the Middle School of the Kennebunks canceled its annual community Thanksgiving dinner in response to pertussis outbreaks.

Maine’s pertussis rate of 27.7 cases per 100,000 population was the worst in the nation in 2017 – the latest year for state-by-state comparisons – and more than five times the national average, according to the U.S. Centers for Disease Control and Prevention.

Peter Michaud, a nurse and attorney for the Maine Medical Association, said children who for medical reasons can’t be vaccinated, such as those with leukemia, are especially vulnerable to hospitalization or dying if they catch a vaccine-preventable disease.

Michaud said people are opting out of vaccines not because they have a philosophic or religious exemption, but because they incorrectly fear that the vaccines are unsafe.

“People are not getting the vaccines because of a misunderstanding of the science,” he said. “Children keep getting sick, avoidably.”

jlawlor@pressherald.com

First Day on the job- Governor Janet Mills signs Medicaid Expansion

Congratulations and thank you Governor Janet Mills!

MaineWriter- Health care was a major voter issue in the 2018 election.  Governor Mills was right to keep her promise to implement the Medicaid Expansion, on the first day of her administration.

Maine's new governor had vowed to expand Medicaid on 'day one' of her administration, making more than 70,000 Mainers eligible for health insurance.

Maine Governor Janet Mills taking the oath of office administered by President of the Maine Senate Troy Jackson

By Joe Lawlor PPH

AUGUSTA, Me- Gov. Janet Mills signed an executive order on Thursday, to begin implementing Medicaid expansion, which she had vowed to do on “day one” of her administration. 

More than 70,000 Mainers will be eligible for Medicaid health insurance under the expansion. Mills was sworn into office on Wednesday evening, and signed “Executive Order 1” on Thursday.

“More than a year ago, the people of Maine voted to expand Medicaid. Today, my administration is taking the long-awaited steps to fulfill their will,” Mills, a Democrat, said in a statement. 

“I am directing my administration to begin implementing Medicaid expansion as quickly and as efficiently as possible so that we can help more Maine people access the health care they need.”

Maine voters approved Medicaid expansion by a 59 to 41 percent margin in a November, 2017 referendum, but former Republican Gov. Paul LePage, an expansion opponent, refused to implement it. A lawsuit that attempted to force the LePage administration to implement the expansion won in court, but LePage dragged out the process, leaving implementation to Mills.

According to a news release, the executive order “directs the Department of Health and Human Services to make changes to process the applications of Mainers seeking health care coverage under Medicaid expansion, including amending the filings of the previous administration to reflect the accurate date of implementation and to seek the earliest possible approvals as allowed under the expansion act.”

Jeanne Lambrew, who was nominated by Mills to be health and human services commissioner, said in a statement, “Governor Mills and I share a commitment to ensuring that the Department of Health and Human Services achieves its core mission to safeguard the health and well-being of Maine children and families. The Executive Order is a critical first step in achieving that mission,” Lambrew said in a statement. “Full implementation of Medicaid expansion will take time and the collective cooperation of our health system, but with Governor Mills’ leadership, access to affordable health care coverage for Mainers is now on the horizon.”

Robyn Merrill, executive director of Maine Equal Justice Partners, the group that campaigned for the referendum and sued the LePage administration for failure to implement it, said having an administration that supports the goals of Medicaid expansion “feels lighter and more hopeful.”

“The implications are significant for people’s lives,” Merrill said. “They won’t be delaying the care they need, like they did when they were uninsured. Medicaid expansion is going to become a reality, finally. It’s taken a long time.”

Senator Collins prides herself on understanding Maine voters - Now it's time for her to prove it!

Maine's clarion call to Senator Susan Collins:

Vote "no"- do not approve Judge Brett Kavanaugh :  

Portland City Hall - A message to Senator Susan Collins beamed in light: "Roe v Wade is more popular than Brett Kavanaugh"

Jacqueline Curley wrote, "Judge Kavanaugh has shown his cards on women's abortion rights and protection of the environment.  In addition, he perjured himself to get the judgeship he now has.  Have the backbone to vote no, Susan!" 

Columnist Bill Nemitz wrote: 

As she prepares to vote yea or nay, she should take a long, hard look at the political landscape.

Senator Susan Collins has long prided herself on never missing a vote in the U.S. Senate. But of all the thousands she’s cast in her 21 years on Capitol Hill, this is the one on which Sen. Susan Collins’ legacy will hinge.

She can vote later this month to confirm Brett Kavanaugh to the U.S. Supreme Court and hope – no, make that pray – that he stands by his assurance to her that Roe. v. Wade is “settled law.” (Whatever that means.)

Or she can open her eyes to what many others already see – that Kavanaugh represents the tipping point in the never-ending battle over a woman’s right to choose an abortion – and vote to keep him off the highest court in the land.

“I know it’s frustrating to the press, but until I finish my review I’m going to defer my decision-making,” Collins told Portland Press Herald reporter Joe Lawlor, as the weeklong hearing on Kavanaugh’s nomination concluded with two questions still unanswered:

Would Kavanaugh, or would he not, provide the crucial fifth vote on the court to overturn Roe. v. Wade, the landmark abortion decision that for 45 years has rightly left to a woman and her physician the decision on whether to proceed with a pregnancy?

Or, short of tossing out Roe. v. Wade in its entirety, would Kavanaugh and the rest of the court’s conservative block embark on a piece-by-piece dismantling of a woman’s right to choose until, as a skeptical Sen. Angus King put it, all that’s left of the historic ruling is “a hollow shell”?

She can vote later this month to confirm Brett Kavanaugh to the U.S. Supreme Court and hope – no, make that pray – that he stands by his assurance to her that Roe. v. Wade is “settled law.” (Whatever that means.)

Or she can open her eyes to what many others already see – that Kavanaugh represents the tipping point in the never-ending battle over a woman’s right to choose an abortion – and vote to keep him off the highest court in the land.

Or, short of tossing out Roe. v. Wade in its entirety, would Kavanaugh and the rest of the court’s conservative block embark on a piece-by-piece dismantling of a woman’s right to choose until, as a skeptical Sen. Angus King put it Friday, all that’s left of the historic ruling is “a hollow shell”?

Brett Kavanaugh, if he taught us one thing during his often-rocky hearing last week, is not that dumb.

Rather, he hemmed and hawed and, when the going got really tough, simply rebuffed any and all attempts to discern where he stands on abortion and other critical issues of our time.

Thus, we are left to consider what did leak out: The now infamous 2003 email in which Kavanaugh, at the time working for the George W. Bush administration, opined: “I am not sure that all legal scholars refer to Roe as the settled law of the land at the Supreme Court level since Court can always overrule its precedent, and three current Justices on the Court would do so.”

Collins was quick to point out that Kavanaugh meant other “legal scholars,” not himself. Perhaps, but if I were Maine’s senior senator, Kavanaugh’s quickness to acknowledge that school of thought would at least give me pause.

In a similar vein, Kavanaugh in his testimony Thursday referred to contraceptives as “abortion-inducing drugs” while describing a case involving insurance coverage for all forms of birth control.

Let’s dispense with the fact that such hot-button language, a staple of the anti-abortion movement, is scientifically wrong – as a multitude of scientific and medical experts later noted on Twitter.

More significantly, the phrase offered a fleeting glimpse into the thinking of a man hellbent on not letting the world see inside his head – or, for that matter, his heart – when it comes to a woman’s right to control her own body.

“Saying ‘abortion-inducing drugs’ to describe contraception is straight out of the anti-choice, anti-science phrase book used to restrict women’s access to essential health care,” noted the Center for Reproductive Rights on Twitter.

The problem with Collins, as she inches her way toward what looks like a vote to confirm Kavanaugh, is that she’s trying to have it both ways.

She holds firm to her pro-choice reputation by vowing that she will oppose any nominee “hostile” to Roe v. Wade. But when it comes to rooting out such hostility, she appears more than willing to take Kavanaugh at his word and steer clear of what may lie hidden among the weeds.

Put more simply, she seems far too trusting of what Kavanaugh told her – echoing last winter’s debacle when she voted for massive high-end tax cuts in exchange for Senate Majority Leader Mitch McConnell’s promised protections of the beleaguered Affordable Care Act. After the tax bill passed, the promises went poof.

Some argue that Collins’ naiveté last winter was a ruse – that she knew all along she’d be shortchanged by McConnell, yet forged ahead on the assumption that voters would forget all about it before she has to face them again in 2020.

Maybe so. But as she now prepares to vote yea or nay on Kavanaugh, Collins would do well to take a long, hard look at the political landscape.

More than a dozen cases involving abortion currently are queued up at the Supreme Court’s doorstep – any one of which could spell the beginning of the end for Roe. v. Wade.

Kavanaugh, if confirmed, will all but certainly side with the court’s other conservatives in those cases – dealing one or more blows to Roe v. Wade if not dismantling it altogether.

And, with all of that playing out under the shadow of the looming 2020 election, Mainers long comfortable with Collins and her pro-choice persona will find themselves in a decidedly different mood when it comes to her political future.

The word “hostile” comes to mind.

Mental Health Care is suffering a crises for lack of provider services

Hospitals’ illegal rejection of mentally ill patients puts spotlight on Maine’s chronic lack of services
Published in the Portland Press Herald by Joe Lawlor

Health care experts say the incidents in Lewiston, Maine point to weaknesses and gaps in a system that's unable to meet demand and forces people into emergency departments and jails.

The disclosure that two Lewiston hospitals were found to have illegally rejected patients who arrived at their emergency departments with mental health issues has highlighted a chronic lack of services for mental illness in Maine.

Behavioral health experts, hospital executives and law enforcement officials say the state’s mental health system is riddled with weaknesses and gaps in critical services.

The problems range from a lack of early intervention programs that would stop mental health problems from becoming a crisis, to a dearth of outpatient services and inpatient beds. Simply put, there aren’t enough places for patients who are grappling with serious mental health problems but don’t need to be in a hospital emergency department.

“You either have the hospitals or jail,” Cumberland County Sheriff Kevin Joyce said. 

“Well, a lot of people don’t fall into either of those two categories. But there’s no other options, so people end up in one place or the other.”

In Lewiston, Central Maine Medical Center and St. Mary’s Regional Medical Center illegally turned away patients who were having mental health crises, according to state inspection reports that were posted online last week by Disability Rights Maine, a protection and advocacy agency for people with disabilities.

Both hospitals have since filed corrective plans with the federal government to avoid losing federal funding. Hospital officials described being overwhelmed with mental health patients and not having enough resources to help them as a reason they were turned away from the hospital. In some cases, hospitals had “disruptive” mental health patients arrested.

Supply outstripped by demand:
But the issues in Lewiston are symbolic of the lack of mental health services available outside of emergency departments and jails, experts say.

Joyce said 80 percent of the inmates at the Cumberland County Jail have a mental illness, and many would be receiving mental health services at other locations and not in jail if other options existed.

Some people are charged with misdemeanors so they can be in jail, with the understanding that the charges will be dismissed once they find a suitable mental health service, he said. 

In one case, an inmate stayed at the Cumberland County Jail for 200 days while waiting for a slot to open up, Joyce said.

“I operate the largest mental health facility in the state of Maine,” he said.

Thousands of Mainers are being transported to hospitals for mental health reasons every year, according to Maine Emergency Medical Services data compiled by the Portland Press Herald. 

In 2017, there were 7,602 mental health transports by ambulances in Maine, about 2.2 percent of all ambulance runs.

After they arrive, some people stay for weeks at hospital emergency departments – long after they’ve stabilized and don’t need to be there – while waiting for an inpatient bed to open up.

Dr. Robert McCarley, medical director for Maine Behavioral Healthcare Intensive Services, said bottlenecks occur at many points along the spectrum of mental health services. 

Those bottlenecks can cause patients to stay much longer than needed in hospital emergency departments.

“At this point, the demand is almost always greater than the supply,” McCarley said. “We need a system with much more resources than we have now.”

For instance, Spring Harbor Hospital in Westbrook, which is part of Maine Behavioral Healthcare, has 100 inpatient beds for mental health patients – 60 for adults and 40 for children, McCarley said. But only about 10 become available each day, while there are often 30 or more psychiatric patients waiting in emergency rooms in the MaineHealth system, including at Maine Medical Center in Portland.

Emergency Room is "A Holding Pen"

Not all need an inpatient bed at a psychiatric hospital, McCarley said, but some need other services that aren’t readily available, such as outpatient services or something called a crisis stabilization unit, a place where patients can go if they don’t need to be in a psychiatric hospital but need residential treatment.

State Sen. Cathy Breen, D-Falmouth, whose adult daughter has a mental illness, said that in the past two years, her daughter was stuck at emergency departments twice while waiting for an inpatient psychiatric bed – once for nine days and the other time for five days.

“When you’re having a mental health crisis, being in the emergency room is clearly counterproductive,” Breen said. “It’s a holding pen. It’s the exact opposite of what most people in a mental health crisis need. We have a very broken system.”

Jenna Mehnert, executive director of the National Alliance on Mental Illness Maine, said the system has many shortcomings that need to be addressed, including a lack of prevention and early intervention programs, as well as resources for those in crisis.

“The emergency department is far from the ideal place to go,” Mehnert said. “But it’s the least bad place that we have right now.”

Mehnert is advocating that Maine open up five “receiving centers,” also known as “assessment centers,” where many of the mentally ill patients in crisis could go instead of emergency rooms or jails. 

Such centers are typically staffed with psychiatrists and nurses and support workers who specialize in mental health services.

Some states or counties have created receiving centers, including in Texas, Arizona, California and Pennsylvania, but they are not yet widespread.

Joyce said he also is looking at models in other states, including the one in Texas, to see if it makes sense for Maine. Joyce said he believes receiving centers could fill a gap in mental health services similar to how urgent care centers can serve patients with problems that need immediate attention but don’t rise to the level of an emergency department visit.

Mehnert said the entire mental health system needs to be looked at. When Maine de-institutionalized in the 1980s and 1990s, the community-based system that replaced it was not well designed.

“There is a lack of a real plan,” Mehnert said. “We do not have a robust menu of services.”

The Options .....are insufficient

Mehnert said there are 669 psychiatric beds in Maine, including long-term care for the most severely mentally ill, such as those residing at Riverview Psychiatric Center in Augusta and Dorothea Dix Psychiatric Center in Bangor.

She said it’s unclear what the average demand is for beds, but the demand exceeds supply.Advertisement

Breen said the beds were not available for her daughter, even though her family had private health insurance, a reliable way to pay for the services.

Jeff Austin, vice president of government affairs for the Maine Hospital Association, said one of the big problems surrounding mental health care is the lack of reimbursement for staying at hospitals for mental health care. If a patient has stabilized and is merely waiting for a bed to open up somewhere else, Medicaid often won’t reimburse the hospital for that time, even though it’s costing the hospital money. And if the patient is uninsured – a common occurrence among the homeless, for instance – trying to find a place where the patient can be safely discharged is even more difficult, Austin said.

“Every state is struggling with this issue,” Austin said. “The options we have in the community are insufficient to meet the need.”

Joe Lawlor can be contacted at 791-6376 or at:

jlawlor@pressherald.com

Twitter: joelawlorph